Trends and Clinical Outcomes in Patients Undergoing Primary Percutaneous Revascularisation for ST-elevation Myocardial Infarction: A Single Centre Experience

Luke P. Dawson, Josephine Warren, Juan Mundisugih, Viveka Nainani, William Chan, Dion Stub, Archer Broughton, Andrew J. Taylor, Antony Walton, Stephen J. Duffy, James A. Shaw

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Abstract

Background: Primary percutaneous coronary intervention (PPCI) is the preferred therapy for patients presenting with ST-elevation myocardial infarction (STEMI). We reviewed patients undergoing PCI for STEMI over a six-year period to evaluate changes in procedural characteristics and clinical outcomes given recent changes to STEMI guidelines. Methods: All patients presenting to the Alfred Hospital, a tertiary referral hospital, between 1 January 2010 and 31 December 2015 undergoing PCI for STEMI were identified. Detailed review of their procedure reports was performed and 30-day and 12-month clinical outcomes were recorded including major adverse cardiac events (MACE). Results: There was a total of 445 patients aged 60.6. ±. 12.4 years with 369 (82.9%) male. There was a significant increase in radial access use over the six-year period 0/49 (0%) in 2010 vs 56/113 (49.6%) in 2015 (p. <. 0.01). There was a significant reduction in the use of IIb/IIIa receptor antagonists during the period 29/49 (59%) in 2010 vs 24/113 (21%) in 2015 (p. <. 0.01) and use of aspiration thrombectomy 15/49 (31%) in 2010 vs 19/113 (17%) in 2015 (p. <. 0.01). There was no significant reduction in major bleeding over this period with 2/49 (4%) in 2010 vs 5/108 (5%) in 2015 (p = 0.32). Thirty-day and 12-month mortality was also unchanged. Conclusion: Between 2010 and 2015 there has been a significant increase in the use of radial access and a reduction in the use of glycoprotein IIb/IIIa antagonists and aspiration thrombectomy in patients undergoing PPCI. This was not associated with changes in major bleeding or 30-day or 12-month mortality.

Original languageEnglish
Pages (from-to)683-692
Number of pages10
JournalHeart Lung and Circulation
Volume27
Issue number6
DOIs
Publication statusPublished - Jun 2018

Keywords

  • Aspiration thrombectomy
  • Myocardial infarction
  • Percutaneous coronary intervention

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